In recent years, advocates in the US and abroad have come out in full force for period positivity, working to destigmatize menstruation by pushing legislators to abolish taxes on feminine hygiene products or to provide free pads or tampons in public schools. However, we still have a long way to go.
A new report in BMJ Global Health reveals how the global "culture of silence" around vaginal bleeding, including menstruation and other circumstances, puts the lives of women and girls in low and middle-income countries at risk.
Marni Sommer is an associate professor of socio-medical sciences at Columbia University's Mailman School of Public Health, and has been working on the issue of menstruation and girls' education in low- and middle-income countries for about 12 years. Because of the growing attention to that issue globally, she and her co-authors wondered how girls and women manage vaginal bleeding beyond their monthlies. They surveyed past research and realized that the data was limited. In other words, women's global health issues continue to be understudied and under-addressed.
"As much silence as exists around menstruation, there seems to be even more silence around other types of vaginal bleeding—for which there are many types," she tells Broadly. "Silence in terms of their experiences, silence in terms of if they are getting information they need to stay healthy, and silence around how they are managing in the absence of adequate, safe, easily accessible water and sanitation facilities."
"As much silence as exists around menstruation, there seems to be even more silence around other types of vaginal bleeding—for which there are many types"
According to the report, the average woman will experience a total of 2,400 period days between the ages of 12 and 51. Those days, however, don't account for abnormal circumstances, where there may be excessive bleeding. Additionally, there are a number of reasons beyond menstruation for why a woman or girl might experience an episode of vaginal bleeding, including as a result of endometriosis, uterine fibroids, miscarriage or an STI.
"All vaginal bleeding episodes potentially cause subjective experiences of fear, discomfort and anxiety," the report states. That's why it's imperative people have access to information resources and health care support. The problem is, the report continues, that many cultures consider it taboo to talk about vaginal bleeding. As a result, many girls and women are too afraid of being shamed or ostracized to ask questions or seek help when they experience abnormal bleeding.
"Just as in the USA (and other high-income countries), this just isn't a topic that you bring up at the dinner table or in daily conversations," Sommer explains. "I think in some societies and cultures, girls' and women's bleeding is seen as polluting or as very powerful—that often was information learned through anthropologists and other social scientists who spent time doing in-depth exploration of the issue of menstrual bleeding in particular. I think in many contexts, people perceive vaginal bleeding as something dirty or shameful or not appropriate for shared conversation."
Another issue impacting women and girls in low- and middle-income countries is the lack of access to water, sanitation, and hygiene facilities. "While the information, supplies, support, and breaking of taboos is essential, the aspect that frequently gets overlooked or under-addressed is that of toilets," Sommer says. "Toilets are not very sexy to talk about—but imagine if post-partum (bleeding) women in the US, or those with endometriosis, or who have had a miscarriage … didn't have a safe, clean easily accessible toilet at home, work and school to use: Would they really be able to engage in daily life during the daytime and nighttime?"
"There is a real gap in what we know about this issue and as public health researchers … it's essential for us to explore and understand better," Sommer continues. "I think that just as Gloria Steinem famously said about how if men could menstruate, things would be different—in relation to the availability of information, improved supplies/technologies, facilities, etc."